Annals of Surgical Oncology

, Volume 11, Issue 1, pp 14–20 | Cite as

Application of molecular diagnosis for detection of peritoneal micrometastasis and evaluation of preoperative chemotherapy in advanced gastric carcinoma

  • Takuji Mori
  • Yoshiyuki Fujiwara
  • Yurika Sugita
  • Takashi Azama
  • Takaaki Ishii
  • Kazuhiro Taniguchi
  • Keiji Yamazaki
  • Shuji Takiguchi
  • Takushi Yasuda
  • Masahiko Yano
  • Morito Monden
Original Articles

Abstract

Background

In advanced gastric cancer, peritoneal recurrence is the main cause of death after curative surgical resection. The aim of this report was to describe a novel approach for quantitative genetic diagnosis using peritoneal lavage for the identification of patients at high risk for peritoneal recurrence and for evaluation of the clinical response to intraperitoneal chemotherapy in advanced gastric cancer.

Methods

Nineteen patients with advanced gastric cancer who underwent staging laparoscopy and intraperitoneal chemotherapy before surgical resection or systemic chemotherapy between June 1999 and September 2001 were enrolled in this study. All peritoneal lavage specimens, collected at both staging laparoscopy and gastrectomy, were subjected to real-time quantitative genetic diagnosis.

Results

The reverse transcriptase polymerase chain reaction (RT-PCR) values decreased in 8 cases, stabilized as negative in 5, and increased in 6 during therapy. Patients whose RT-PCR values diminished and were ultimately negative survived except for one, and all but one patient whose values increased during treatment died of recurrence.

Conclusions

Quantitative evaluation of genetic changes can provide accurate, useful information on the effects of preoperative intra-abdominal chemotherapy and overall prognosis for patients with advanced gastric cancer.

Key Words

Gastric cancer Molecular diagnosis Peritoneal dissemination Staging laparoscopy 

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References

  1. 1.
    Dupont JB, Lee JR, Burton GR, Cohn I Jr. Adenocarcinoma of the stomach: review of 1497 cases.Cancer 1978;41:941–7.PubMedCrossRefGoogle Scholar
  2. 2.
    Yamada E, Miyaishi S, Nakazato H, et al. The surgical treatment of cancer of the stomach.Int Surg 1980;65:387–99.PubMedGoogle Scholar
  3. 3.
    Bando E, Yonemura Y, Takeshita Y, et al. Intraoperative lavage for cytological examination in 1,297 patients with gastric carcinoma.Am J Surg 1999;178:256–62.PubMedCrossRefGoogle Scholar
  4. 4.
    Benevolo M. Diagnostic and prognostic value of peritoneal immunocytology in gastric cancer.J Clin Oncol 1998;6:3406–11.Google Scholar
  5. 5.
    Noh SH, Yoo CH, Chung HC, Roh JK, Shin DW, Min JS. Early postoperative intraperitoneal chemotherapy with mitomycin C, 5-fluorouracil and cisplatin for advanced gastric cancer.Oncology 2001;60:24–30.PubMedCrossRefGoogle Scholar
  6. 6.
    Yonemura Y, de Aretxabala X, Fujimura T, et al. Intraoperative chemohyperthermic peritoneal perfusion as an adjuvant to gastric cancer: final results of a randomized controlled study.Hepatogastroenterology 2001;48:1776–82.PubMedGoogle Scholar
  7. 7.
    Yu W, Whang I, Averbach A, Chang D, Sugarbaker PH. Prospective randomized trial of early postoperative intraperitoneal chemotherapy as an adjuvant to resectable gastric cancer.Ann Surg 1998;228:347–54.PubMedCrossRefGoogle Scholar
  8. 8.
    Hamazoe R, Maeta M, Kaibara N. Intraperitoneal thermochemotherapy for prevention of peritoneal recurrence of gastric cancer: final results of a randomized controlled study.Cancer 1994;73:2048–52.PubMedCrossRefGoogle Scholar
  9. 9.
    Majima T, Ichikura T, Mochizuki H. Prognostic significance of the cytologic features of free cancer cells in the peritoneal cavity of patients with gastric cancer.Surg Today 2002;32:35–9.PubMedCrossRefGoogle Scholar
  10. 10.
    Nakanishi H, Kodera Y, Torii A, et al. Detection of carcinoembryonic antigen-expressing free tumor cells in peritoneal washes from patients with gastric carcinoma by polymerase chain reaction.Jpn J Cancer Res 1997;88:687–92.PubMedGoogle Scholar
  11. 11.
    Noura S, Yamamoto H, Ohnishi T, et al. Comparative detection of lymph node micrometastases of stage II colorectal cancer by reverse transcriptase polymerase chain reaction and immunohistochemistry.J Clin Oncol 2002;20:4232–41.PubMedCrossRefGoogle Scholar
  12. 12.
    Yoshioka S, Fujiwara Y, Sugita Y, et al. Real-time rapid reverse transcriptase-polymerase chain reaction for intraoperative diagnosis of lymph node micrometastasis: clinical application for cervical lymph node dissection in esophageal cancers.Surgery 2002;132:34–40.PubMedCrossRefGoogle Scholar
  13. 13.
    Okada Y, Fujiwara Y, Yamamoto H, et al. Genetic detection of lymph node micrometastases in patients with gastric carcinoma by multiple-marker reverse transcriptase-polymerase chain reaction assay.Cancer 2001;92:2056–64.PubMedCrossRefGoogle Scholar
  14. 14.
    Kaneko K. Establishment of a visible peritoneal metastatic model from a gastric adenocarcinoma cell line by green fluorescent protein.Int J Oncol 2000;16:893–8.PubMedGoogle Scholar
  15. 15.
    Japanese Gastric Cancer Association. Gastric cancer. In:Japanese Classification of Gastric Carcinoma. 2nd English ed. 1998:10–24.Google Scholar
  16. 16.
    Chromezynski P, Satti N: Single-step method of RNA isolation by acid guanidium thiocyanate-PhOH-chloroform extraction.Anal Biochem 1987;162:156–9.CrossRefGoogle Scholar
  17. 17.
    Miyake Y, Fujiwara Y, Ohue M, et al. Quantification of micrometastases in lymph nodes of colorectal cancer using real-time fluorescence polymerase chain reaction.Int J Oncol 2000;16:289–93.PubMedGoogle Scholar
  18. 18.
    Yoo CH, Noh SH, Shin DW, Choi SH, Min JS. Recurrence following curative resection for gastric carcinoma.Br J Surg 2000;87:236–42.PubMedCrossRefGoogle Scholar
  19. 19.
    Tateishi M, Ichiyoshi Y, Kawano T, Toda T, Minamisono Y, Nagasaki S. Recurrent pattern of digestive tract carcinoma in the Japanese: comparison of gastric cancer to colon cancer.Int Surg 1995;80:41–4.PubMedGoogle Scholar
  20. 20.
    Chromezynski P, Sacchi N. Single-step method of RNA isolation by acid guanidium thiocyanate-PhOH-chloroform extraction.Anal Biochem 1987;162:156–9.CrossRefGoogle Scholar
  21. 21.
    Yonemura Y, Fujimura T, Ninomiya I, et al. Prediction of peritoneal micrometastasis by peritoneal lavaged cytology and reverse transcriptase-polymerase chain reaction for matrix metalloproteinase-7 mRNA.Clin Cancer Res 2001;7:1647–53.PubMedGoogle Scholar
  22. 22.
    Schmidt P, Thiele M, Rudroff C, et al. Detection of tumor cells in peritoneal lavages from patients with gastrointestinal cancer by multiplex reverse transcriptase PCR.Hepatogastroenterology 2001;48:1675–9.PubMedGoogle Scholar
  23. 23.
    Fujimura T, Yonemura Y, Nakagawara H, et al. Subtotal peritonectomy with chemohyperthermic peritoneal perfusion for peritonitis carcinomatosa in gastrointestinal cancer.Oncol Rep 2000;7:809–14.PubMedGoogle Scholar
  24. 24.
    Yonemura Y, Fujimura T, Fushida S, et al. Hyperthermo-chemotherapy combined with cytoreductive surgery for the treatment of gastric cancer with peritoneal dissemination.World J Surg 1991; 15:530–6.PubMedCrossRefGoogle Scholar
  25. 25.
    Yu W, Whang I, Suh I, Averbach A, Chang D, Sugarbaker PH. Prospective randomized trial of early postoperative intraperitoneal chemotherapy as an adjuvant to resectable gastric cancer.Ann Surg 1998;228:347–54.PubMedCrossRefGoogle Scholar
  26. 26.
    Fujimura T, Yonemura Y, Fushida S, et al. Continuous hyperthermic peritoneal perfusion for the treatment of peritoneal dissemination in gastric cancers and subsequent second-look operation.Cancer 1990;65:65–71.PubMedCrossRefGoogle Scholar
  27. 27.
    Fujimoto S, Shrestha RD, Kokubun M, et al. Intraperitoneal hyperthermic perfusion combined with surgery effective for gastric cancer patients with peritoneal seeding.Ann Surg 1988;208:36–41.PubMedCrossRefGoogle Scholar
  28. 28.
    Francois Y, Grandclement E, Sayag-Beaujard AC, Glehen O, Sadeghi-Looyeh. Intraperitoneal chemo-hyperthermia with mitomycin C in cancer of the stomach with peritoneal carcinosis.J Chir 1997;134:237–42.Google Scholar
  29. 29.
    Hamazoe R, Maeta M, Kaibara N. Intraperitoneal thermo-chemotherapy for prevention of peritoneal recurrence of gastric cancer: final results of randomized controlled study.Cancer 1994;73:2048–52.PubMedCrossRefGoogle Scholar
  30. 30.
    Shimada K, Ajani JA. Adjuvant therapy for gastric carcinoma patients in the past 15 years: a review of western and oriental trials.Cancer 1999;86:1657–68.PubMedCrossRefGoogle Scholar
  31. 31.
    Yano M, Tsujinaka T, Shiozaki H, et al. Appraisal of treatment strategy by staging laparoscopy for locally advanced gastric cancer.World J Surg 2000;24:1130–6.PubMedCrossRefGoogle Scholar

Copyright information

© The Society of Surgical Oncology, Inc 2003

Authors and Affiliations

  • Takuji Mori
    • 2
  • Yoshiyuki Fujiwara
    • 2
  • Yurika Sugita
    • 2
  • Takashi Azama
    • 2
  • Takaaki Ishii
    • 2
  • Kazuhiro Taniguchi
    • 2
  • Keiji Yamazaki
    • 1
  • Shuji Takiguchi
    • 2
  • Takushi Yasuda
    • 2
  • Masahiko Yano
    • 2
  • Morito Monden
    • 2
  1. 1.Department of SurgeryShinsenri HospitalOsakaJapan
  2. 2.Department of Surgery and Clinical Oncology, Graduate School of MedicineOsaka UniversitySuita-City, OsakaJapan

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